Prevalence Of Rotator Cuff Injuries During High School Versus College Football Games

Despite the increase in shoulder-related injuries in high school football, limited research has been conducted to compare the prevalence and severity of injuries specific to the rotator cuff as they relate to higher levels of competition. PURPOSE: To quantify rotator cuff injuries during high school and college football games. METHODS: In sum, 104 high schools and 41 universities in the contiguous US participated over 14 (2010-23) and 16 (2006-21) seasons, respectively. Outcomes of interest were injury severity, injury category, primary type of injury, injury situation and mechanism, player and skill position, environmental factors, surface type, and imaging/surgical procedures. Injury incidence rates (IIR) were calculated as injuries per 10 games. RESULTS: Of the 4557 high school and 2864 college games, 507 total injuries were reported with 255 in high school and 252 in college. MANOVAs indicated a significant competitive effect by injury severity (F3,503 = 13.733; P < .001), injury category (F2,504 = 32.031; P < .001), primary type of injury (F6,500 = 213.905; P < .001), injury situation (F11,495 = 2.589; P < .001) and mechanism (F9,497 = 11.007; P < .001), player (F2,504 = 11.124; P < .001) and skill position (F7,499 = 5.428; P < .001), and imaging/surgical procedures (F2,504 = 5.033; P = .002). Post hoc analyses [IIR, (95% CI)] indicated significantly lower (p < .05) incidence of total injuries [0.6, (0.5-0.6) vs 0.9, (0.8-1.0)], minor (0-6 days time loss) [0.2, (0.2-0.3) vs 0.5, (0.4-0.5)] and substantial injuries (7-21 days time loss) [0.2, (0.2-0.2) vs 0.3, (0.2-0.3)], player collisions [0.5, (0.4-0.5) vs 0.6, (0.5-0.6)], muscle strains [0.4, (0.4-0.5) vs 0.7, (0.6-0.8)] and tears [0.1, (0.1-0.1) vs 0.1, (0.1-0.2)], and total imaging/surgical procedures [0.2, (0.2-0.2) vs 0.3, (0.2-0.3)] during high school vs college games, respectively. Findings indicated surface-impact related rotator cuff trauma was minimal across all surfaces compared to player collisions. CONCLUSION: Although rotator cuff injuries were lower during high school play, the incidence of injury is approaching the collegiate level of trauma. To reduce the long-term decrease in health-related quality of life associated with shoulder injuries, attention to rotator cuff strength and ROM is recommended at the high school level.